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Integration and Continuity of Primary Care: Polyclinics and Alternatives – a Patient-Centred Analysis of How Organisation Constrains Care Co-Ordination HEALTH SERVICES AND DELIVERY RESEARCH VOLUME 3 ISSUE 35 AUGUST 2015 ISSN 2050-4349 Integration and continuity of primary care: polyclinics and alternatives – a patient-centred analysis of how organisation constrains care co-ordination Rod Sheaff, Joyce Halliday, John Øvretveit, Richard Byng, Mark Exworthy, Stephen Peckham and Sheena Asthana DOI 10.3310/hsdr03350 Integration and continuity of primary care: polyclinics and alternatives – a patient-centred analysis of how organisation constrains care co-ordination Rod Sheaff,1* Joyce Halliday,1 John Øvretveit,2 Richard Byng,3 Mark Exworthy,4 Stephen Peckham5 and Sheena Asthana1 1School of Government, Plymouth University, Plymouth, UK 2Medical Management Centre, Karolinska Institutet Stockholm, Stockholm, Sweden 3Health Services Management Centre, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK 4Centre for Health Services Studies, University of Birmingham, Birmingham, UK 5Department of Health Services Research and Policy, University of Kent, Kent, UK *Corresponding author Declared competing interests of authors: none Published August 2015 DOI: 10.3310/hsdr03350 This report should be referenced as follows: Sheaff R, Halliday J, Øvretveit J, Byng R, Exworthy M, Peckham S, et al. Integration and continuity of primary care: polyclinics and alternatives – a patient-centred analysis of how organisation constrains care co-ordination. Health Serv Deliv Res 2015;3(35). Health Services and Delivery Research ISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). Editorial contact: [email protected] The full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journal Reports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programme The Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012. The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services. For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This report The research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 09/1801/1063. The contractual start date was in February 2011. The final report began editorial review in August 2014 and was accepted for publication in November 2014. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report. This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. © Queen’s Printer and Controller of HMSO 2015. This work was produced by Sheaff et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. Published by the NIHR Journals Library (www.journalslibrary.nihr.ac.uk), produced by Prepress Projects Ltd, Perth, Scotland (www.prepress-projects.co.uk). Health Services and Delivery Research Editor-in-Chief Professor Ray Fitzpatrick Professor of Public Health and Primary Care, University of Oxford, UK NIHR Journals Library Editor-in-Chief Professor Tom Walley Director, NIHR Evaluation, Trials and Studies and Director of the HTA Programme, UK NIHR Journals Library Editors Professor Ken Stein Chair of HTA Editorial Board and Professor of Public Health, University of Exeter Medical School, UK Professor Andree Le May Chair of NIHR Journals Library Editorial Group (EME, HS&DR, PGfAR, PHR journals) Dr Martin Ashton-Key Consultant in Public Health Medicine/Consultant Advisor, NETSCC, UK Professor Matthias Beck Chair in Public Sector Management and Subject Leader (Management Group), Queen’s University Management School, Queen’s University Belfast, UK Professor Aileen Clarke Professor of Public Health and Health Services Research, Warwick Medical School, University of Warwick, UK Dr Tessa Crilly Director, Crystal Blue Consulting Ltd, UK Dr Peter Davidson Director of NETSCC, HTA, UK Ms Tara Lamont Scientific Advisor, NETSCC, UK Professor Elaine McColl Director, Newcastle Clinical Trials Unit, Institute of Health and Society, Newcastle University, UK Professor William McGuire Professor of Child Health, Hull York Medical School, University of York, UK Professor Geoffrey Meads Professor of Health Sciences Research, Faculty of Education, University of Winchester, UK Professor John Norrie Health Services Research Unit, University of Aberdeen, UK Professor John Powell Consultant Clinical Adviser, National Institute for Health and Care Excellence (NICE), UK Professor James Raftery Professor of Health Technology Assessment, Wessex Institute, Faculty of Medicine, University of Southampton, UK Dr Rob Riemsma Reviews Manager, Kleijnen Systematic Reviews Ltd, UK Professor Helen Roberts Professor of Child Health Research, UCL Institute of Child Health, UK Professor Helen Snooks Professor of Health Services Research, Institute of Life Science, College of Medicine, Swansea University, UK Professor Jim Thornton Professor of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Nottingham, UK Please visit the website for a list of members of the NIHR Journals Library Board: www.journalslibrary.nihr.ac.uk/about/editors Editorial contact: [email protected] NIHR Journals Library www.journalslibrary.nihr.ac.uk DOI: 10.3310/hsdr03350 HEALTH SERVICES AND DELIVERY RESEARCH 2015 VOL. 3 NO. 35 Abstract Integration and continuity of primary care: polyclinics and alternatives – a patient-centred analysis of how organisation constrains care co-ordination Rod Sheaff,1* Joyce Halliday,1 John Øvretveit,2 Richard Byng,3 Mark Exworthy,4 Stephen Peckham5 and Sheena Asthana1 1School of Government, Plymouth University, Plymouth, UK 2Medical Management Centre, Karolinska Institutet Stockholm, Stockholm, Sweden 3Health Services Management Centre, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK 4Centre for Health Services Studies, University of Birmingham, Birmingham, UK 5Department of Health Services Research and Policy, University of Kent, Kent, UK *Corresponding author [email protected] Background: An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level. Objectives: To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider
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